Peripheral Artery Disease

Heart patients often have Peripheral Artery Disease

Peripheral Artery Disease also known as PAD is when the arteries in the legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. It is the same process that causes heart disease. It doesn’t just happen in the heart it can occur elsewhere in the body and this is known as PAD.  When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Lower-extremity PAD is a serious disease that affects about 8 million Americans. The hardened arteries found in people with PAD also put them at risk for hardening and narrowing of the arteries to the kidneys and the brain. That is why people with  heart disease are at risk for PAD, kidney disease and stroke.

How do I know if I have PAD?

Working in cardiac rehabilitation I would often encounter patients who ended up having peripheral artery disease and were unaware of it.  Some of the tell tale signs would be pain with walking, or complaining of wooden feeling in the legs when walking. Fatigue, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but that goes away when you rest.  This discomfort often goes away within two to five minutes of rest. This is a  very classic symptom.  Another classic symptom is night pain in legs, calves, feet or toes that wakes you up. Many patients describe having to sit at the edge of the bed and dangle their feet or get up and walk to relieve the discomfort. Be alert as well for slow to heal wounds in the legs or feet, as the poor blood supply limits wound healing is another clue to peripheral artery disease. Changes in the color of your legs, or the temperature – often the limb feels cold, looks whitish or bluish.

Smoking and PAD

If  you are a heart patient and a smoker  you are very likely to have PAD.  Smoking is  the number one cause of PAD.  Studies show that smoking even half a pack of cigarettes per day may increase the risk of having PAD by 30 to 50 percent. If you do smoke it is imperative that you quit as soon as possible. A cardiologist I worked with would tell his patients if you are diabetic and smoke you will lose a limb to PAD it is a matter of when not if.

Diabetes and PAD

The other big risk factor is diabetes. Diabetes makes the arteries narrow and hard thus restricting blood flow. People with diabetes are at higher risk for having PAD.  Some studies have found that one out of three people with diabetes over age 50 has PAD, and PAD is even more common in African Americans and Hispanics who have diabetes.  The challenge of course with this is that if blood flow is reduced wounds do not heal properly, and limbs can become necrotic and require amputations. A challenge with diabetes is that often the patients with PAD will not get the classic leg pain symptoms. For this reason any diabetic with risk factors for PAD should have his/her legs checked regularly.

Testing for PAD

Testing for PAD includes palpating for pulses in the foot and ankle region. If pulses are not easily felt then the next step is a Doppler ABI – Ankle Brachial Index measurement. This is a painless test in which the blood pressure of the arms is compared to the blood pressures in the lower leg. If there is a large difference this suggests PAD.  Other imaging including CT scans may be done. The next step is a segmental MRA -magnetic resonance angiography,- like a heart catheterization  but looking at the vasculature below the heart. 

Treatment of PAD

Treatment is similar to the heart. If the disease is in the small vessels it is better to intervene with risk factor modification and exercise. Yes it hurts to walk but paradoxically walking is the best activity to help re route the blocked blood supply. The more a person walks the more likely they will develop what is known as collateral arteries around the blockage. Other risk factor modification issues include stopping smoking, lowering cholesterol, being physically active, and keeping blood pressure in control.

If the blockage is in primary arteries of the legs or kidneys then interventions include angioplasty, stenting and/or bypassing the blockages. These are all very similar to the interventions done for atherosclerosis of the heart. Once an intervention is done  it is important to understand the issue is not fixed. Like a car it will need continual maintenance. There is high probability that is will continue to develop further blockages even if you modify all the risk factors and walk regularly.

Exercise and PAD

Many Cardiac Rehabilitation programs will also offer a PAD walking program as well. This usually involves walking on a treadmill or riding a bike 5 days per week and working your way up to a one hour walk. Most patients who experience pain while walking think that sound impossible to walk one hour. The walking program is a graduated program in which one works their way up to one hour, and usually it isn’t a fast walk, but may include walking a grade. Most patients find it quite do able once started. Many find the support given through the rehabilitation programs makes all the difference, as they wouldn’t do it on their own, and the education received while attending gives them the understanding needed to cope with this chronic condition.

 From the Vascular Disease Foundation WHY WALK?

Walking can make a real difference for people with peripheral artery disease (PAD). Recent studies show that for many people with PAD, a structured walking program is one of the best treatments for reducing leg pain or cramps (claudication) when walking. In fact, studies show that over time a structured walking program is often more effective and can work better than medicine or surgery in helping people with PAD walk longer and further without having to stop due to pain.

A regular walking program will:

  • Let you do more and stay active.
  • Reduce stress and help you relax.
  • Help you control your blood glucose, blood pressure, cholesterol, and body weight.
  • Improve muscle tone.
  • Lower your chances of having a heart attack or stroke.
  • Give you peace of mind that you are taking care of your health.

For more information visit

http://vasculardisease.org/

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Get more out of your Walk

Walking, seems like a no brainer right? We don’t really think about it we just do it as it is natural. There are things you can do  to get improve benefits of walking. By focusing on style and posture you can improve muscle strength and tone, improve balance, correct postural issues and burn more calories.

Engage your arms!

Make a loose fist, consciously swing your arms, bringing your fist up to the approximate level of your breast bone, and then back to the outside of the hip. Pretend you are trying to move your arms against a force to engage the muscles even more when you walk.

Notice the posture of President Bush  – Shoulders back, arms active, stomach in,  head forward. Now compare to the gentleman next to him. Who do you think is getting more from their walk?

 Forward head, not engaging arms or stomach, rounded shoulders.

I show this to make you think about your posture while on a treadmill. Fast walkers on a treadmill who hang on to the bar often have a sway back posture. Slow walkers often lean way forward – I call it the pushing the lawnmower posture. While on the treadmill, try to either not hold on and swing your arms, or hold on with only one arm.  This will help you to have a better posture. When you hold on to the rails the entire time, your upper body is stiff and doesn’t move naturally as it does with your regular walking.

Also don’t look down the whole time this leads to forward head or thoracic kyphosis postures. Try to look 15-20 feet ahead of you. Hold your head high. Try to keep your chin parallel to the floor.  Squeeze those shoulder blades together and down…this is the military posture or the busty look, tall and proud.

Some people are so stiff with walking, add a little wiggle to your walk allow your shoulders and hips to move naturally, this is very good for your spine. Being stiff and rigid isn’t helpful. Often after open heart surgery people are very stiff in the shoulders and neck. Again swinging the arms helps this.

Tighten your stomach muscles. These support your back, they provide you with core strength. If the belly sags forward it places more stress on your lumbar spine. Tuck your pelvis under your torso.

If your have back issues or balance issues I recommend walking with ski poles. They help you to stand taller, force you to engage your arms with the walk, and you burn more calories on your walk.

Compared to regular walking, ski walking  involves applying force to the poles with each stride. Walking with ski poles uses more of their entire body (with greater intensity) and receive fitness building stimulation not present in normal walking for the chest, lats, triceps, biceps, shoulder, abdominals, spinal and other core muscles. This can produce up to a 46% increase in energy consumption compared to walking without poles. It also has been demonstrated to increase upper body muscle endurance by 38% in just twelve weeks.

This extra muscle involvement may lead to enhancements over ordinary walking at equal paces such as:

  • increased overall strength and endurance in the core muscles and the entire upper body
  • significant increases in heart rate at a given pace
  • increasing vascular pathways and oxygen delivery efficiency
  • greater ease in climbing hills
  • burning more calories than in plain walking
  • improved balance and stability with use of the poles
  • significant un-weighting of hip, knee and ankle joints
  • provides density preserving stress to bones

What about walking with weights? 

If you want to walk with weights don’t use more than 1-2 lbs in your hands. Heavier weights tend to stress the neck and spine and are not recommended. Again don’t just hold the weights pump those arms, swing up to breast bone and back to hip. You engage the arms, you burn more calories.